Confidentiality in Couples and Group Thearpy

Confidentiality in couples and family therapy

Couples and family therapy carry a greater inherent risk when it comes to breaching confidentiality. It is common for couples therapists to receive complaints about confidentiality breaches, especially when the therapist chooses to see the couple both individually and as a couple. It can be difficult to keep track of who told you what and what information you are supposed to know and not know – that is why it is essential to have clear boundaries and guidelines when working with couples and families. Below is a list of strategies that some therapists uses to navigate the complexity of the situations.

Only seeing couples together, never individually

  • This is the safest option as the couple always knows what is being said as they are both in the room at the same time. Couples therapy can be a particularly hostile environment, and sometimes they will attempt to get the therapist on ‘their side’ by trying to convince them outside of the session that they are right and their partner is wrong.

Have a ‘No Secrets Policy’

  • Whether you choose to see the couple individually or as a group, it is important to have a ‘No Secrets Policy’ that outlines the nature of the confidential relationship between the group and not the individual. Explain the no-secrets policy in the first session and obtain verbal and written consent. You can have the policy as a separate document or as a point within your initial consent form.

Establish Clear Boundaries

  • Clearly communicate the limits of confidentiality at the beginning of therapy. Explain what information will be kept confidential and under what circumstances you might need to break confidentiality to others (e.g., risk of harm) or within the therapeutic group (addictions, affairs, gambling etc.)

Addressing Potential Conflicts

  • Discuss with the couple how you will handle situations where there may be a conflict between maintaining confidentiality and ensuring the safety and well-being of one or both individuals. This will be inline with your ethical values and the way you conduct your sessions. Some therapists prefer not to disclose affairs and leave them hidden while supporting the other partner to end the affair. The risk here is that if the other partner finds out that you knew, there will be a breach of trust in the dynamic.

Supervision and Consultation

  • Seek supervision or consultation when faced with challenging ethical dilemmas. Discussing the situation with a more experienced colleague can provide valuable insights and guidance.
Implementation suggestions

The manner of the therapist in divulging confidentiality acts as another variable. Here are some common practices (Kuo, 2009):

  1. The therapist will suggest to the individual that certain information be shared to the partner in the following conjoint session, such as the presence of sexually transmitted diseases. Before that, the therapist will provide a few individual sessions that work towards the client’s fear of disclosure and coach her or him how to express the secret.
  2. Before suggesting the individual confide to the partner, the therapist will give the individual a limited time period for stopping certain behaviours, such as active extramarital affairs, or will help the individual stop the problems, such as excessive spending.
  3. If the individual refuses to confide to the partner, the therapist will share the information and may refer the couple to other alternatives
  4.  In the situation that the individual refuses to share the information, the therapist will not share the specific information. The therapist will inform the couple that “she or he is aware of information obtained from one partner that makes it impossible to do couple therapy 

References

Kuo, F.-C. (2009). Secrets or No Secrets: Confidentiality in Couple Therapy. American Journal of Family Therapy, 37(5), 351–354. https://doi.org/10.1080/01926180701862970